Jejunal diverticula bleeding: A challenging diagnosis entity

Table 1 Bowel diverticular disease: Clinical overview

Study variable		Duodenum diverticula	Jejunum diverticula	Ileum diverticula	Colon diverticula
Epidemiology[14,19]	Prevalence	15%-42% (second most common in small bowel)	0.3%-2.3% (higher in Asia)	< 5% (usually jejunoileal)	30%-75% (most common worldwide)
	Age presentation	60-80 years old	Elderly patients	> 50 years old	> 60 years old
	Incidence	5%-10% (Western countries)	0.4%-4.6% (necropsy findings)	< 1%	10%-50%
Clinical presentation[29,37]		Upper GI bleeding; melena	Most commonly asymptomatic; bleeding, nausea, vomiting, diarrhea, vague abdominal pain	Hematochezia or melena	Hematochezia (90%); usually painless
Bleeding characteristics[30]		Usually mild to moderate	Often massive	Variable often self-limited	Most cases stop spontaneously
Diagnostic challenges[3]		Periampullary development	“Silent entity” if uncomplicated; Inaccessible through standard endoscopy	Site development	Intermittent bleeding
Endoscopic treatment[3,39]		60%-80% success rate	Enteroscopy useful in bleeding cases: If diagnosis is suspected	Limited data	Successful in 85%-95%
Re-bleeding rates[2]		20%-35% within 1 year	20% after initial endoscopic management	Limited data	10%-25% within 1 year

The epidemiology, clinical presentations, bleeding patterns, diagnostic challenges, and endoscopic management of diverticula throughout the gastrointestinal tract are described. Although jejunal diverticula are of low prevalence, they are of substantial clinical relevance due to their propensity for severe gastrointestinal bleeding and the diagnostic challenges related to their limited accessibility with conventional endoscopy. GI: Gastrointestinal.

Table 2 Diagnostic modalities in lower gastrointestinal bleeding

Diagnostic modality	Advantages	Disadvantages	Cost-effectiveness
Colonoscopy[2]	Diagnostic and therapeutic tool	Requires bowel preparation Limited in massive active bleeding	High cost-effectiveness due to therapeutic capability
Flexible sigmoidoscopy[3]	Rapid bedside evaluation; minimal preparation	Limited to distal colon	Only in selected cases with suspected distal anorectal pathology
CTA[3]	More widely available and better accuracy in identifying the bleeding site with almost 100% accuracy; high sensitivity (79%-95%) and specificity (95%-100%)	Requires contrast; risk of nephropathy; contrast dye allergic reaction; non-therapeutic	High as initial imaging before angiography or surgery
Catheter angiography[2,3]	Diagnostic[18] and therapeutic; identifies the bleeding source in 25%-70% of the cases	Invasive; risk of bowel ischemia (30%)	Moderate
Technetium-99m-tagged red blood[1] cell scintigraphy[2,3]	Reveals intermittent bleeding Non-invasive	Low spatial resolution; may not precisely locate accurate bleeding site	Moderate
Video capsule endoscopy[2]	Non-invasive diagnostic alternative that allows the entire small bowel to be explored in 79%-90%	Only diagnostic; risk of capsule retention in 2% of patients undergoing study for small bowel bleeding	Low
Barium small bowel study[2]	Identifies structural abnormalities	Low sensitivity in active bleeding	Low

CTA: Computed tomography angiography.